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UTILITY PERMIT APPLICATION I <br /> CISY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-88 i0 - FAX 425-257-8857 — �rv�•dw.everettwa.org • <br /> I <br /> i5�o 3(0� sT S ve.✓�f�- u�G _ <br /> PROJECT ADDRESS <br /> ��a�.. ,�;do�' �_? <br /> � F!Operty Ov:ner r:taJ Ad�ress CiP� S[ate�Zip Phcne <br /> 'enenl Name Qf th��s is `cr a conmerCial businessj � � <br /> i�- ��I.�QIw►r.�� � � f.o. 55y / vr,,a.e.-F1- ,'�7-0(� <br /> g—_ — <br /> �� Gordrar_;cr �;ta:inaore_� [.�.ty Slaio2ip °^�r� <br /> �-f�M�l3l�Z9��71ti1s � -�"o�7Y�� <br /> , `.':A State Contiac'or L�ceose ��lumber (reqwred) � ' City of Eve:etl�Business License Number(reqwred) <br /> �Nork to be done: <br /> ❑ Side Se�.ver Repair � <br /> ❑ Side Sewer Alteration ' <br /> ,. , <br /> ❑ Side Sewer - New Installation <br /> Install Backwater Valve�(outside the building) I <br /> i : , <br /> !� ❑ Cap off Sewer I <br /> ' ❑ Install V�Jater Meter. FEE � I ! <br /> ;; � 3a ° J � ; <br /> ' � r�- Qj —/� � PERP+rr.: <br /> S�gnature � Uatc � I 1 ' ( � y O�� I <br /> , L-{ � <br /> ll <br /> I - <br />